PACS:
1. n. (acronym)Picture Archiving and Communications System. A device or group of devices and associated network components designed to store and retrieve medical images.
2. n. (acronym)Pain And Constant Suffering.

Sunday, October 28, 2007

The geniuses at JibJab have done it again with a series of do-it-yourself (sort of) videos. Above is one of a zillion possible permutations. See what you can do with it! There's also a version for Democrats, if you happen to be of that persuasion.

On October 26 at 9:14 AM EDT, someone from Intelerad in Montreal, Quebec, became user number 50,000. Congratulations to the lucky reader. I'll be sending out your prize momentarily. You are now the proud owner of a 30-day trial version of the InteleViewer Workstation software! What's that? You already have one? Oh well...

We continue to use InteleViewer quite successfully at our site that still has no PACS. For $500 annually, I think it beats eFilm hands down. Frankly, for $5000 annually it would beat eFilm hands down. Outside of open source software, this is the best deal around for the smaller operation.

October has been the best month yet, and it isn't even over! Check out the stats:

Thursday, October 25, 2007

Every year, my friends at AuntMinnie.com review the various radiological offerings to be found at RSNA. Since I seem to make the trek to Chicago every year for this extravaganza, I appreciate AM's attempt to distill the thousand plus booths down to the hundred or so that I can actually visit. I actually do attend the education sessions at RSNA, which can be quite a frustrating experience with literally 50 of them going on simultaneously.

I have taken the liberty of copying AuntMinnie's PACS Preview and posting it below:

Agfa HealthCare(Booth 4106) Agfa HealthCare will highlight six suites of its Impax portfolio, each targeted at specific healthcare segments, at the 2007 RSNA conference.

Amicas(Booth 2583) Amicas will feature version 5.5 of its Vision Series PACS network and introduce version 2.0 of its Vision Reach module in its RSNA booth this year.

Eclipsys(Booth 6959) Expect Atlanta-based Eclipsys to focus on enhancements to its Sunrise PACS line at this year's RSNA show.

Emageon(Booth 8508) Emageon of Birmingham, AL, will spotlight its RadSuite Express PACS offering at McCormick Place in Chicago.

Empiric Systems(Booth 5738) Empiric Systems of Morrisville, NC, plans to demonstrate version 5.0 of its Encompass.Net RIS/PACS network in its 2007 RSNA booth.

Fujifilm Medical Systems USA(Booth 1129) Fuji will highlight the latest version of its Synapse PACS software at this year's RSNA conference in Chicago.

GE Healthcare(Booth 1729) Expect GE to feature its recent acquisition of PACS vendor Dynamic Imaging. On the product side, version 3.0 of Centricity Imaging-PACS will be highlighted in the company's RSNA booth.

Siemens Medical Solutions(Booth 7713) Siemens will direct RSNA attendees to developments with its syngo platform, as well as a range of advanced visualization software.

Thinking Systems(Booth 4583) Thinking Systems of St. Petersburg, FL, will debut new PET/CT and cardiac imaging functions for its ThinkingPACS line at this year's RSNA meeting.

Visage Imaging(Booth 2591) Visage Imaging, a subsidiary of Mercury Computer Systems, will place its Visage PACS/CS into the limelight at the 2007 RSNA conference.

Visus Technology Transfer(Booth 8401) Visus Technology Transfer of Bochum, Germany, will present new enhancements for its JiveX system on the RSNA show floor at McCormick Place.

Voyager Imaging(Booth 4050) Voyager Imaging of East Hawthorn, Australia, plans to focus on the benefits of its Voyager PACS image data prefetching technique.

I'm not seeing many new names this year, but perhaps the good news is that the vast majority of this rogue's gallery were present last year. I'm personally thrilled that Jive-X PACS made it another season.

To give Mike Cannavo, the One and Only PACSMan some fodder for his annual awards, just look at the names of some of the other systems. iMagic? Is that how it works? Carestream? Sounds like something a urologist might prescribe. MedSynapse? Uh, Fuji, are you taking note of this? Oh, Medsynaptic is based in Pune, India, and is likely out of the reach of trademark infringement suits. I notice Visage/Mercury doesn't mention their acquisition of SoHard software from Germany anymore. Helium PACS? Does it float, or do we talk funny after inhaling it? Eclipsys has Sunrise PACS; isn't that somewhat of a contradiction in terms?

I always thought the name "Freedom PACS" would be great; freedom from tyranny, freedom from bloatware, freedom from things that get in your way, and so on. The title is for sale, cheap.

The roadmap naturally notes the acquisition of Dynamic Imaging by GE, and we're all anxious to see how the booths merge. The sad fact is that if everyone who has ever been associated with DI (including users, potential buyers, lookie-loo's like me, etc) gathered in a corner of the GE booth, they might well take up about 5% of GE's massive plantation on the exhibit floor.

The way things are going, the 2015 RSNA PACS roadmap will probably be a lot shorter: GE, Siemens, Philips, maybe one or two others. These behemoths will have gobbled up everybody else. I have the feeling, though, that open source PACS, or at least vendor-neutral archives might reinvigorate the smaller operators in this game. We'll see. In the meantime, I really think Connect Imaging needs to bring me out to their place in Honolulu to have a look at their PACS Dashboard and other offerings....

Bandaged from head to toe to show the importance of the new PACS technology at Seaforth Community Hospital, Don Morton, of Seaforth, adds to the total as donations came into the Seaforth Legion or were called in to CKNX radio during the annual Healthcare Heroes radiothon held on Saturday. Photo by Susan Hundertmark, courtesy http://www.seaforthhuronexpositor.com/

You won't hear about this in many places, but PACS is a pretty expensive proposition. So what is a small hospital with limited funds going to do when it decides to take the plunge?

If you work at the Seaforth Community Hospital in East Huron, Ontario, you hold a Radiothon!

The Seaforth Community Hospital foundation came very close to achieving its goal of $50,000 with $49,713 in donations during the annual CKNX Healthcare Heroes radiothon on Saturday.“It was a very successful day with just terrific community support,” said foundation chair Ron Lavoie on Monday. . .(S)ome of the larger donations included $5,000 from the Seaforth TD-Canada Trust, $2,500 from the Seaforth CIBC and $1,000 from the Seaforth Lions Club.

PACS technology allows diagnostic tests, including nuclear medicine, CT scans, x-rays and ultrasounds to be produced with digital images, which can then be transferred electronically.Adding in the amount raised at Saturday’s radiothon, the foundation has raised $175,713 of its goal of $213,283 for the first phase of the PACS fundraising.When the first phase is achieved, Lavoie said the next three years will be spent working towards the second phase - $350,000 towards a new x-ray machine for SCH.

Dr. Heather Percival, a physician on staff at Seaforth Community Hospital, who apparently is not a radiologist, noted:

"This technology is absolutely essential. It’s important to keep us at the same level as the city hospitals. Without this technology, we are back in the so-called dark ages,” she said. Percival pointed out that small towns have to work hard to fundraise for up-to-date technology, pointing out that some U.S. cities have more MRIs than the entire province of Ontario.

OK, everyone, take note. This is the end product of National Health Care. Radiothons to buy PACS systems. No doubt the Foundation will be holding a bake-sale to continue to fund their PACS. They will eventually have to pay for a viewing station, electricity, Cat 5 cables, and so on.

The US health-care consumer probably would never consider phoning in a donation to pay for his or her scanner. I really think some out there are anticipating Hillary-care with glee, thinking the government will give us the same level of service we get now, but for free. Sure. Right. Just ask the fine citizens of East Huron how much "free" care they're getting. You might want to ask them how much tax they pay, in addition to radiothon donations. I wonder if said donations are tax-deductable in Canada?

Monday, October 22, 2007

I generally agree with Walt Mossberg's technology assessments, published in the Wall Street Journal. I am not, however, a Palm Treo aficionado like Walt is, and I think he needs to get himself a new cell-phone. But that's a minor disagreement.

Cell-phones are the topic of Walt's latest rant, Free My Phone, published in today's WSJ. Walt is disturbed about the limitations placed on technology by the US cell-phone carriers:

Suppose you own a Dell computer, and you decide to replace it with a Sony. You don't have to get the permission of your Internet service provider to do so, or even tell the provider about it. You can just pack up the old machine and set up the new one. . .

This is the way digital capitalism should work, and, in the case of the mass-market personal-computer industry, and the modern Internet, it has created one of the greatest technological revolutions in human history, as well as one of the greatest spurts of wealth creation and of consumer empowerment.

So, it's intolerable that the same country that produced all this has trapped its citizens in a backward, stifling system when it comes to the next great technology platform, the cellphone.A shortsighted and often just plain stupid federal government has allowed itself to be bullied and fooled by a handful of big wireless phone operators for decades now. And the result has been a mobile phone system that is the direct opposite of the PC model. It severely limits consumer choice, stifles innovation, crushes entrepreneurship, and has made the U.S. the laughingstock of the mobile-technology world, just as the cellphone is morphing into a powerful hand-held computer.

That's why I refer to the big cellphone carriers as the "Soviet ministries." Like the old bureaucracies of communism, they sit athwart the market, breaking the link between the producers of goods and services and the people who use them.

To some extent, they try to replace the market system, and, like the real Soviet ministries, they are a lousy substitute. They decide what phones can be used on their networks and what software and services can be offered on those phones. They require the hardware and software makers to tailor their products to meet the carriers' specifications, not just so they work properly on the network, but so they promote the carriers' brands and their various add-on services.

Now, the tie-in to PACS is obvious, and this really parallels the argument I presented in my older post, "Euros, Assumptions, and Greek Islands," wherein I bemoaned the fact that one cannot place an interface from Company A on Company B's archive.

It's somewhat ironic that I should be taking this stance. Remember my post about my visit with Dr. Bernie Huang? When I saw PACS in its infancy, it seemed to me that the only way it would be practical would be to package it in one box, i.e., sell the archive, the viewing stations, and probably the wires themselves as one package. I have to think I was right at the time, and in fact this approach represents about 99% of the PACS installs out there at the moment.

But today, PACS has matured and things have come full circle. There are vendors that make great GUI's, but are said to have weak back-ends, archive architecture, and some that have just the opposite reputation. Some use Windows components, and some use Sun/Unix based Oracle databases. There are SANs, NAS's, tape drives, DVD archives, and so on. Yes, I'm throwing a number of disparate elements into this mix, but you get the idea. Why should we be married to one company for every aspect of the PACS solution? Right now, the answer is that the vendors have us locked into the status quo. If you don't agree, just call your vendor and tell them you are going to migrate to another company's GUI. The only way to do so is to forklift out what you have and transfer all the data to the new system, GUI, archive, and all. Not so easy. It's just like trying to take your AT&T phone and migrating it to Sprint. You can't. It's not technically possible, because they are incompatible systems. At least PACS data can be migrated after a fashion, although any peculiarities in the way data is stored (like compression, for example) will bung up the process. (For a fantastic discussion of databases and archives and migration thereof, please have a look at Mike Cannavo's latest Aunt Minnie article, "Exploring PACS Secrets -- Straight talk about archiving and data migration.")

The thought of opening up PACS in the manner proposed is probably giving execs for the major vendors chest pain, or perhaps something lower. They will claim that this concept will interfere with patient care because their system won't work as it should. I respectfully disagree. Mossberg cites a similar decoupling in the telecom industry, that worked quite well:

We've been through this before in the U.S., though many younger readers may not recall it.

Up until the 1970s, when the federal government intervened, you weren't allowed to buy your own landline phone, and companies weren't able to innovate, on price or features, in making and selling phones to the public. All Americans were forced to rent clumsy phones made by a subsidiary of the monopoly phone company, AT&T, which claimed that, unless it controlled what was connected to its network, the network might suffer.

Well, the government pried that market open, and the wired phone network not only didn't collapse, it became more useful and versatile, allowing, among other things, cheap connections to online data services.

I suspect that if the government, or some disruptive innovation, breaks the crippling power that the wireless carriers exert today, the free market will deliver a similar happy ending.

Tuesday, October 09, 2007

As DeForest Kelly, Mark Lenard, and James Doohan have discovered, the fame of Star Trek is fleeting at best, and eventually one must shuffle off this mortal coil, and go to the Great Beyond. Of course, James Doohan did indeed make it into space postumously, as his ashes were sent on a suborbital flight along with those of astronaut Gordon Cooper and 200 others.

But short of that, how can a Trekkie take the Star Trek Universe with him or her when he beams off this planet for the last time?

Eternal Image, maker of funerary for the passionate, has the following solutions:

The Star Trek Casket is designed after the photon-torpedo case used as Mr. Spock's casket in Star Trek II: The Wrath of Khan (image courtesy of: http://www.mikedunn.com):

For those so inclined, the 24th century reminescent Urn might be the best place to put your ash(es):

These items will not be available until next year, so please refrain from dying until then.

Wednesday, October 03, 2007

My friend Peter McClennan, President and COO of Amicas, apparently will depart that position at the end of the year. I was tipped off last night to check Amicas' SEC filings, and discovered this:

(b) On October 1, 2007, AMICAS, Inc. (the "Company") notified Peter A. McClennen, the Company's President and Chief Operating Officer, that the Employment Agreement between Mr. McClennen and the Company dated March 28, 2005 (the "Employment Agreement") would not be renewed. The Employment Agreement provides that either party is entitled to give written notice of an intention not to renew the Employment Agreement prior to its expiration date, December 31, 2007, provided that such notice was given within a specified time frame. Mr. McClennen's employment with the Company will cease as of December 31, 2007

I think that's legalese for "they are parting ways".

I've come to know Peter over the years, and he is very capable and personable. He has nicely overcome his GE background and I think really helped to put Amicas on the map. I would hire him if I could afford him, which I can't.

I have only two bones to pick with Amicas as run by Peter. First, he appears to have supervised the removal of the beloved Green Amoeba logo:

The replacement is just not as catchy:

Secondly, Amicas has blamed DRA-2005 in large part for lackluster sales. I have had some discussions on this topic with some of the other execs at Amicas, and I guess we'll agree to disagree.

Dr. Steve Kahane, Chairman and CEO, will take over Peter's duties come January. Steve is also incredibly capable and personable as well, and I'm sure he'll do just fine. He is no newcomer to this sort of thing, having headed Datamedics and VitalWorks in the past.

I hope Peter doesn't go back to GE, but if he does, maybe he can turn around some of the mentality that gave us Centricity as it exists today. (More on that in an upcoming post!) Best of luck! I'll be glad to write a letter of recommendation, although a letter from this Dalai Lama might not be exactly helpful....